• Consultant JMO Dr. Ruchira Nadeera notes the need to address the lack of human resources/facilities, and the imperative of digitalising records 

The field of forensic medicine engages in a number of activities that are of concern to the general public, with a focus on supporting the Judiciary to provide informed and accurate verdicts. While this field is interesting in so many ways, the number of professionals entering the field is inadequate. The field, on the other hand, is facing several issues – including the lack of facilities.

One way of making the process of judicial medical officers (JMO) supporting legal proceedings more effective is by digitalising the keeping of records that are in the possession of JMOs, which will help them when they have to provide evidence in various courts from time to time. Explaining this, the Consultant JMO attached to the District General Hospital (DGH), Nawalapitiya, Dr. Ruchira Nadeera, noted the societal notion that JMOs engage only in examining dead bodies for court cases as a misconception. He added that the situation of JMOs, especially when it comes to how they perform their duties, is considerably different to that of other countries. To provide their expert opinion, he added, the field requires more support and recognition.

He made these statements during an interview with The Daily Morning which focused on the nature and the status quo of the field in the Sri Lankan context. 

The following are excerpts from the interview:

The general public has limited knowledge on the roles and responsibilities of a JMO. Can you shed some light on the main functions of JMOs in Sri Lanka?

A JMO is a medical officer, who has a Bachelor of Medicine, Bachelor of Surgery (MBBS) qualification. A JMO provides medical evidence to the court, and that is where the judicial part comes from.

Whenever a court has a case regarding the human body, the court might need medical evidence to come to a conclusion on the case, which we call a verdict. In such cases, JMOs come as expert witnesses, and give evidence regarding medicines, the body, or related topics. We gather medical evidence, either by a post-mortem or clinical examination.

If the person in question is dead, we have to conduct a post-mortem and gather information. In such cases, we provide opinions about the cause of death, which may involve examining and explaining the injuries that the deceased may have suffered before death. When it comes to clinical explanations when the person in question is not dead, we have to conduct examinations as a doctor, gather relevant information, and provide medical evidence.

Once we gather medical evidence, we have to interpret it in line with the history of the person in question. For example, if the case concerns a road traffic accident, we have to examine the person and the injuries, and determine whether the injuries are actually the result of a road traffic incident. Interpretations correlate with situations in which a person sustained injuries or died. Afterwards, once we are done with these examinations, we give evidence before a court of law as expert witnesses – either by sending a report or by oral evidence. This part is expected to assist the court to arrive at a reasonable conclusion, or a verdict. 

What is more, we sometimes have to conduct field visits, depending on the situation, in order to gather the relevant information to provide evidence before a court.

What sort of skills or qualifications should one have to become a JMO?

According to the Evidence Ordinance, one has to have an MBBS degree to become an expert witness in this field before a court, and that is the first qualification. In addition, JMOs learn more regarding forensic medicine, where we obtain the relevant diploma. Once a person obtains the diploma, they can then go for a doctorate, which is known as a Doctor of Medicine (MD) in forensic medicine. Becoming a consultant JMO also involves obtaining overseas training, as in the case of becoming a consultant in many other fields, and it allows you to obtain specialist knowledge in forensic medicine. After completing this process, you are considered a consultant JMO. 

When a JMO gets involved in a judicial process, what are the limitations that apply?

We are not supposed to give evidence regarding matters that are beyond our expertise, and we are confined to medical evidence. For example, if we are asked about something regarding physics or biochemistry that does not come under our purview, in such instances, we are not supposed to give evidence.

Another limitation pertains to the information that is available to us. For example, if a person has died due to some kind of pesticide ingestion, we are not supposed to determine what the toxin was. We send samples to the Government Analyst, and the latter sends a report regarding the toxin that has been ingested. Based on that report, we give evidence about the cause of death. We need to have a referral.

We get other forms of referrals which also involve specialists. Among them are, for example, referrals related to psychiatry, neurology, sexually transmitted diseases, and odontology. We get data from them as well, and incorporate that in our report. It is then easier for the court. Otherwise, the court has to ask them (specialists from various fields) to come to court in person.

What are the main factors that a JMO has to take into account during this process, especially those on which your opinion depends?

When it comes to examinations conducted by us, we never know whether a death was a murder, and therefore, we consider every death as a result of a crime until proven otherwise. JMOs face situations where an incident or death seems like a natural incident, but once the investigation or the post-mortem is done, they realise that it cannot be a normal death.

When we conduct the post-mortem, we have to consider every death as being the result of a crime or a murder. We then have to take into account the history and the background, for which we obtain the Police statement, and that is very important.

We coordinate with law enforcement authorities, and sometimes, we have to go to the place of death. We conduct the necessary external examinations on the body first, before we cut open the body. At this stage, we examine the clothes on the deceased thoroughly – which are important especially when it comes to murders – and take all the trace materials from the clothes. That is one consideration. In addition, we examine other particles attached to the body. Only once that process is finished do we go on to examine the internal organs.

What are the common misconceptions about JMOs or their job?

Everyone thinks that we deal only with matters relating to post-mortems, or dead bodies. But that is not the case. We have to deal with both dead bodies and living people. We do a lot of other related activities such as basic investigations. And we examine people who have faced abuse – including sexual abuse, those who have had abortions, children – especially those who have faced abuse, victims of road traffic accidents – including those that involve drivers under the influence, those who have faced assaults, and people who are addicted to various forms of narcotics. There are so many other areas that we deal with, about which people don’t know.

What are the challenges faced by JMOs in Sri Lanka?

A JMO's job is not a very attractive area, even for a doctor. It often involves conducting post-mortems, and mostly dealing with dead bodies. There is a huge shortage of doctors who enter this field. Even if you are a specialist, a JMO does not have a lot of space to engage in private practice like other surgeons or doctors. So, financially, you have an ordinary status. Those who have entered this field, however, like the field and find it interesting. However, careerwise, many doctors are reluctant to enter the field. Facilities are another major concern. JMOs have very limited, very basic facilities. Because of that, we deal with a lot of stress.

The documentation-related aspect of our job is also concerning. When a normal doctor treats a patient, once the patient receives the necessary treatment, gets cured and is discharged from hospital, the responsibility of the doctor comes to an end. However, in the case of a JMO, that is not the case.

Once a JMO conducts a post-mortem for example, they have to keep the relevant records with them indefinitely and take those records wherever they go. In Sri Lanka, court cases can drag on for about 10-20 years, and therefore, we might have to go to court again and again. Even though we have to keep these documents in our custody, we are not provided with any facility to keep them. Even when we get transferred from one hospital to another, we have to take all the documents with us. With time, the caseload increases, and the documents also increase. The College of Forensic Pathologists of Sri Lanka is conducting some discussion in this regard. They might help get some facilities for this purpose.

In addition, sometimes, giving evidence in court is also a concern. I work in Nawalapitiya. Previously, I have worked in areas such as Ampara, Trincomalee, Badulla, and Vavuniya. So, if I have to appear for a case in Ampara, I have to go there. That is very difficult and time-consuming. Our suggestion is making this process digital. However, most courts don’t have that facility and only a very few have. If there was such a system in every court, we wouldn’t have to travel and our time would have been saved.